Kidney transplantation is the preferred treatment for most of the 615,000 ESRD1 patients in the United States, and is associated with improved quality of life, longer survival, lower hospitalization rates,2 and decreased healthcare costs.3 The adjusted incident rate for ESRD among adults is currently >350 new cases per million population1 and increasing. Living donor kidney transplantation decreased 8.0% while deceased donor kidney transplantation increased slightly (3.4%) from 2010 to 20111 and this gap between living and deceased donor kidney transplant rates continues to grow.1 The decision to choose kidney transplantation over long-term dialysis is a life-altering decision that ESRD patients often make with minimal and usually only subjective data.4 Our team recently developed predictive models to compare short-term 1- and 3-year survival of kidney transplantation versus dialysis5 and packaged into a free-for-download shared decision support tool. The tool showed a significant 53% (p=0.038) improvement in KTx knowledge. However, the tool was designed for use in dialysis facilities and is limited to short-term survival comparisons and currently lacks predictive models to determine long-term outcomes and patient-specific graft survival comparing living donor and deceased donor kidney transplantation. The proposed research will provide a shared-decision tool that explicitly states the needed decisions using a theoretically based medical decision framework, with the personalized focus on options and long-term outcomes.6 The purpose of this study is to develop and validate several risk prediction models of an individual's long- term (5- and 10-year) survival after kidney transplantation compared to dialysis, and calculate an individual's 5- and 10-year graft survival for living and deceased donor kidney transplantation using USRDS7 national data with follow-up on patients through September 2012. This study will apply these developed risk prediction models to iChoose Kidney and test, among 30 participants, the usability of the application while determining the application's impact on kidney transplantation knowledge, patient decision support, and provider satisfaction. Our specific aims for this proposal are: Aim 1: To expand the current iteration of iChoose Kidney to communicate the estimated risks of long- term, post-transplant outcomes for ESRD patients and kidney transplant recipients. Aim 2: Conduct a usability study of ESRD patients seen for first-time kidney transplantation (n=30) to evaluate the feasibility of communicating and interpreting individualized risks for health outcomes.